Individual
DR. JERA NELSON CUNNINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., LCP
Contact information
Practice address
9097 ATLEE STATION RD, MECHANICSVILLE, VA 23116-2525
(804) 730-0432
(804) 730-2829
Mailing address
9097 ATLEE STATION RD, MECHANICSVILLE, VA 23116-2525
(804) 730-0432
(804) 730-2829
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810003467
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
173266
ANTHEM PROVIDER NUMBER
VA
Enumeration date
08/30/2006
Last updated
09/27/2007
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